Krejza J, Arkuszewski M, Radcliffe J, Flynn T B, Chen R, Kwiatkowski J L, Ichord R, Zimmerman R, Bilello M, Ohene-Frempong K, Melhem E R
Department of Radiology, Division of Neuroradiology, University of Pennsylvania; Philadelphia, PA, USA - Department of Nuclear Medicine, Medical University of Gdansk; Gdansk, Poland - Al-Imam Muhammad Ibn Saud Islamic University; Riyadh, Saudi Arabia -
Neuroradiol J. 2012 Jul;25(3):351-9. doi: 10.1177/197140091202500311. Epub 2012 Jun 26.
The aim of this study was to explore whether intellectual performance in children with Sickle Cell Disease and with low risk of stroke as determined with conventional transcranial Doppler ultrasonography (TCD) criteria was associated with hemodynamic parameters in imaging TCD, when controlling for hematological and socio-economical variables and presence of silent infarcts. We performed neuropsychological testing with Kaufman Brief Intelligence Test (K-BIT-IQ) and imaging TCD examinations to measure blood flow velocities and pulsatility indexes (PI) in the middle cerebral arteries (MCA) In 46 children with homozygous HbSS (mean age 108±34 months, range limits: 47-166 months; 24 females), without a history of stroke or transient ischemic attack, with no stenosis on magnetic resonance angiography and with velocities below 170 cm/s in screening conventional TCD. Mean K-BIT IQ Composite and Vocabulary scores (91±13 and 86±14 respectively) were significantly below the average scores of 100 for the age-matched population (one sample t-test=5.21, p<0.001). Using univariate and multivariate regression models, we found that lower PI in the right MCA was associated with lower K-BIT-IQ Composite and Vocabulary scores. Furthermore, we found that interhemispheric differences in PIs were even more strongly associated with neuropsychological performance, whereas flow velocities were not associated with the K-BIT-IQ score. Using a model of chronic anemia, we found that cognitive functioning was associated with cerebral hemodynamics.
本研究的目的是探讨，在控制血液学和社会经济变量以及无症状梗死灶的存在时，根据传统经颅多普勒超声（TCD）标准判定为镰状细胞病且中风风险较低的儿童，其智力表现是否与成像TCD中的血流动力学参数相关。我们使用考夫曼简易智力测验（K-BIT-IQ）进行神经心理学测试，并进行成像TCD检查，以测量大脑中动脉（MCA）的血流速度和搏动指数（PI）。研究对象为46名纯合HbSS儿童（平均年龄108±34个月，年龄范围：47 - 166个月；24名女性），无中风或短暂性脑缺血发作史，磁共振血管造影无狭窄，且在传统TCD筛查中血流速度低于170 cm/s。K-BIT IQ综合得分和词汇得分的平均值（分别为91±13和86±14）显著低于年龄匹配人群的平均得分100（单样本t检验 = 5.21，p<0.001）。使用单变量和多变量回归模型，我们发现右侧MCA中较低的PI与较低的K-BIT-IQ综合得分和词汇得分相关。此外，我们发现PI的半球间差异与神经心理学表现的相关性更强，而血流速度与K-BIT-IQ得分无关。使用慢性贫血模型，我们发现认知功能与脑血流动力学相关。
